title: Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts.
abstract: OBJECTIVE
  Standard therapy of mycotic aneurysms in the descending aorta consists of thoracotomy and in situ graft placement or extraanatomic bypass. The alternative use of endovascular stent-grafts was evaluated for management of infected aneurysms of the thoracic aorta.
  
  
  METHODS
  In a retrospective analysis during a 5-year period, 112 patients underwent stent-graft placement for thoracic aortic aneurysms. Three patients (mean age, 68.6; range, 64-70 years) had mycotic thoracic aneurysms. Stent-grafts were constructed from Z stents covered with polyester fabric and were delivered remotely through a catheter under fluoroscopic guidance.
  
  
  RESULTS
  Complete thrombosis of the mycotic aneurysms was achieved in all patients. One patient required a second separate stent-graft placement procedure because of migration of the initial device; the second patient underwent surgical repair of a ruptured mycotic abdominal aortic aneurysm followed immediately by stent-graft placement for a chronic mycotic thoracic aneurysm; a third patient underwent repair of two infected false aneurysms secondary to complete rupture of a surgical interposition graft. There were no complications of persistent bacteremia despite placement of the stent-graft device at the site of primary infection, reinfection, delayed rupture, paraplegia, distal emboli, or surgical conversion. One patient died of cardiac arrest at 25 months; there were no perioperative deaths (< or = 30 days). The remaining two patients were alive and well at median follow-up of 24 months (range, 4-25 months).
  
  
  CONCLUSIONS
  Endovascular stent-grafts combined with antibiotic therapy may be an alternative to conventional thoracotomy in managing mycotic aneurysms of the descending thoracic aorta.
authors.affiliation: Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, CA 94305-5115, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Semba
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: S M
authors.initials: SM
authors.lastname: Slonim
authors.forename: M K
authors.initials: MK
authors.lastname: Razavi
authors.forename: S T
authors.initials: ST
authors.lastname: Kee
authors.forename: M J
authors.initials: MJ
authors.lastname: Jorgensen
authors.forename: R C
authors.initials: RC
authors.lastname: Hagberg
authors.forename: G K
authors.initials: GK
authors.lastname: Lee
authors.forename: R S
authors.initials: RS
authors.lastname: Mitchell
authors.forename: D C
authors.initials: DC
authors.lastname: Miller
authors.forename: M D
authors.initials: MD
authors.lastname: Dake
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents